Vol. 2, #19
May 14, 2005

Q: I suffer from benign prostatic hyperplasia. Is there anything natural I can take to help with this condition? - Layperson

A: The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds the urethra, the canal through which urine passes out of the body.

Scientists do not know all the prostate's functions. One of its main roles, though, is to squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic.

BPH: A Common Part of Aging

It is common for the prostate gland to become enlarged as a man ages. Doctors call the condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.

Front view diagram of male urinary tract showing normal urine flow from the kidneys through the ureters to the bladder. Urine then passes out of the body through the urethra, which is surrounded by the prostate.

  Normal urine flow.



Side view diagram of male urinary tract showing how an enlarged prostate can squeeze the urethra and block urine flow.

     Urine flow with BPH.

As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH.

Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH.

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. Still, prostate enlargement is as common a part of aging as gray hair. As life expectancy rises, so does the occurrence of BPH. In the United States in 2000, there were 4.5 million visits to a physician for BPH.

Why BPH Occurs

The cause of BPH is not well understood. No definite information on risk factors exists. For centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH.

Throughout their lives, men produce both testosterone, an important male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies done with animals have suggested that BPH may occur because the higher amount of estrogen within the gland increases the activity of substances that promote cell growth.

Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in the prostate, which may help control its growth. Most animals lose their ability to produce DHT as they age. However, some research has indicated that even with a drop in the blood's testosterone level, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage the growth of cells. Scientists have also noted that men who do not produce DHT do not develop BPH.

Some researchers suggest that BPH may develop as a result of "instructions" given to cells early in life. According to this theory, BPH occurs because cells in one section of the gland follow these instructions and "reawaken" later in life. These "reawakened" cells then deliver signals to other cells in the gland, instructing them to grow or making them more sensitive to hormones that influence growth.

Symptoms

Many symptoms of BPH stem from obstruction of the urethra and gradual loss of bladder function, which results in incomplete emptying of the bladder. The symptoms of BPH vary, but the most common ones involve changes or problems with urination, such as

  • a hesitant, interrupted, weak stream
  • urgency and leaking or dribbling
  • more frequent urination, especially at night

The size of the prostate does not always determine how severe the obstruction or the symptoms will be. Some men with greatly enlarged glands have little obstruction and few symptoms while others, whose glands are less enlarged, have more blockage and greater problems.

Sometimes a man may not know he has any obstruction until he suddenly finds himself unable to urinate at all. This condition, called acute urinary retention, may be triggered by taking over-the-counter cold or allergy medicines. Such medicines contain a decongestant drug, known as a sympathomimetic. A potential side effect of this drug may be to prevent the bladder opening from relaxing and allowing urine to empty. When partial obstruction is present, urinary retention also can be brought on by alcohol, cold temperatures, or a long period of immobility.

It is important to tell your doctor about urinary problems such as those described above. In 8 out of 10 cases, these symptoms suggest BPH, but they also can signal other, more serious conditions that require prompt treatment. These conditions, including prostate cancer, can be ruled out only by a doctor's exam.

Severe BPH can cause serious problems over time. Urine retention and strain on the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones, and incontinence. If the bladder is permanently damaged, treatment for BPH may be ineffective. When BPH is found in its earlier stages, there is a lower risk of developing such complications.

Diagnosis

You may first notice symptoms of BPH yourself, or your doctor may find that your prostate is enlarged during a routine checkup. When BPH is suspected, you may be referred to a urologist, a doctor who specializes in problems of the urinary tract and the male reproductive system. Several tests help the doctor identify the problem and decide whether surgery is needed. The tests vary from patient to patient, but the following are the most common.

Digital Rectal Exam (DRE)

This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This exam gives the doctor a general idea of the size and condition of the gland.

Prostate Specific Antigen (PSA) Blood Test

To rule out cancer as a cause of urinary symptoms, your doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer. The U.S. Food and Drug Administration has approved a PSA test for use in conjunction with a digital rectal exam to help detect prostate cancer in men age 50 or older and for monitoring prostate cancer patients after treatment. However, much remains unknown about the interpretation of PSA levels, the test's ability to discriminate cancer from benign prostate conditions, and the best course of action following a finding of elevated PSA.

Rectal Ultrasound

If there is a suspicion of prostate cancer, your doctor may recommend a test with rectal ultrasound. In this procedure, a probe inserted in the rectum directs sound waves at the prostate. The echo patterns of the sound waves form an image of the prostate gland on a display screen.

Urine Flow Study

Sometimes the doctor will ask a patient to urinate into a special device that measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Cystoscopy

In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This procedure is done after a solution numbs the inside of the penis so all sensation is lost. The tube, called a cystoscope, contains a lens and a light system, which help the doctor see the inside of the urethra and the bladder. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.

Treatment

Men who have BPH with symptoms usually need some kind of treatment at some time. However, a number of recent studies have questioned the need for early treatment when the gland is just mildly enlarged. These studies report that early treatment may not be needed because the symptoms of BPH clear up without treatment in as many as one-third of all mild cases. Instead of immediate treatment, they suggest regular checkups to watch for early problems. If the condition begins to pose a danger to the patient's health or causes a major inconvenience to him, treatment is usually recommended.

Since BPH may cause urinary tract infections, a doctor will usually clear up any infection with antibiotics before treating the BPH itself. Although the need for treatment is not usually urgent, doctors generally advise going ahead with treatment once the problems become bothersome or present a health risk.

Plant extracts

A number of plant extracts are popularly used to alleviate BPH, although formal evidence that they are effective is often scanty. However, there is some scientific evidence that an extract of saw palmetto (called Serenoa repens) can be beneficial. If you decide to try a plant remedy, it's always best to discuss this first with your doctor or pharmacist as interactions with conventional medicines are possible.

5-alpha-reductase and aromatase inhibitors

Most every report you'll ever read about benign prostate swelling will tell you that it's caused by a special, potent form of testosterone called DHT (dihydrotestosterone).

  • As men get older, more of our regular testosterone gets turned into DHT.
  • And this process gets 'switched on' by an enzyme called 5-alpha reductase
    The problem is that when the 5-alpha enzyme is blocked, a different enzyme kicks in. This second enzyme is aromatase and it complicates  the situation even more than 5-alpha, because It turns your prostate into an estrogen factory

The enzyme aromatase literally turns your testosterone into the most potent form of estrogen-the female hormone! And too much estrogen in your male body can:

  • Make you impotent...
  • Wipe out any interest in sex...
  • Give you female-looking breasts...
  • And, adding insult to injury, make your prostate swell more
The bark of the tree Pygeum Africanum contains an extract to help the bladder empty and making it easy to start peeing too.

In traditional African medicine, a tea made from the powdered bark of a tall evergreen tree (Pygeum africanum)is sipped to control urinary disorders in men. Today, pygeum is a popular herbal supplement in several parts of the world for benign prostatic hyperplasia (BPH), an enlargement of the prostate gland that can cause urination problems. This harmless condition affects most men over age 50, commonly causing urinary problems.

Pygeum has been approved for treating mild to moderate BPH in Europe since the early 1970s. The bark appears to work by reducing inflammation, promoting urination, and ridding the prostate of cholesterol deposits that can occur with BPH. Symptoms of prostate problems may ease as a result. Pygeum’s use in treating impotence and male infertility has also been explored.

In Western countries pygeum is typically taken in tablet or tincture form. Look for an extract of the plant standardized to contain 13% (total) sterols. Pygeum is commonly sold in combination with other herbs believed to benefit the prostate, such as saw palmetto and nettle.

There are no known drug or nutrient interactions associated with pygeum.

Most importantly, Pygeum seems to block both 5-alpha and aromatase-so here again, you're heading off both causes of prostate misery.

A team from the university of Pisa has discovered that Stinging Nettle(Urtica Radix) lowers blood pressure by relaxing blood vessels. It achieves this by opening potassium channels, decreasing inotropic activity and releasing endothelial nitric oxide. Meanwhile the Freie Universitat in Berlin has found one of the most powerful anti-inflammatories in urtica, which works by retarding the activity of cytokines (substances which cause inflammation by attacking tissue) and this may reduce prostatic inflammation.  Stinging Nettle also contains an incredibly helpful phytonutrient that also blocks both 5-alpha and aromatase.

Pumpkin seeds are rich in protective phytosterols, some very powerful molecules  which appear to help so many men with prostate trouble.
 
Consult a healthcare professional familiar with the use of the above.
 

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DISCLAIMER:  The information in this column, is NOT intended to diagnose and/or treat any health related issues and is provided solely for informational purposes only. Consult the appropriate healthcare professional before making any changes to your healthcare regime. Even what may seem like simple changes in the diet for example, can interact with, and alter, the efficiency of medications and/or the body's response to the medications. Many herbs and supplements exert powerful medicinal effects. Neither the author, nor the website designers, assume any responsibility for the reader's use or misuse of this information.

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